In 2018, vaping company Juul stopped selling some flavored products from stores after facing intense pressure from the FDA to do more to curb youth vaping rates.

A new study by American Cancer Society researchers published in the American Journal of Public Health has indicated that this removal of certain flavors for sale had little-to-no long-term effect on sales, with users quickly switching to other flavors or different brands that were still selling the “sweet” flavors.

“There is no doubt that this is a way to market the products to youth,” said J. Taylor Hays, M.D. Director of the Nicotine Dependence center at Mayo Clinic in Rochester, Minnesota and Professor of Medicine, Mayo Clinic College of Medicine. “The Juul product in particular created ads that showed images of young people using their products and the varied flavors were part of that approach,” Hays added.

The products that Juul pulled from stores in 2018 were e-cigarettes flavored as mango, fruit medley, cucumber and crème brûlée. Using retail data from Nielsen, the researchers discovered that many of these flavors quickly rose in popularity, with fruit flavors representing over $10 million in revenue per month in January 2017. This rose to almost $100 million in October 2018, comprising 1/3 of all of Juul’s sales. In the same time, the sale of tobacco flavored e-cigarettes fell from almost 40% of sales, to just 17% of sales.

“Data from this ACS study also show how dramatically the introduction of Juul affected patterns of youth e-cigarette use and led to the highest levels of youth tobacco use in nearly 20 years,” said Robin Koval, President and CEO of Truth Initiative, a nonprofit public health organization which seeks to make tobacco use a thing of the past.

A 2019 CDC report found that over 5 million American middle- and high-schoolers were e-cigarette users, with the majority favoring cartridge-based devices and flavors being a key reason for use.

“Until November 2017, tobacco was still the most preferred e-cigarette flavor. The introduction of flavored, high nicotine, highly addictive products produced a huge growth in youth usage and consumption of flavored products,” said Koval.

After Juul made the voluntary decision to stop selling some of its sweeter-flavors of e-cigarettes from stores in the U.S. in November 2018, there was a decline in sales of these products by approximately 2/3, but sales of menthol/mint flavored products doubled, with the tobacco-flavored product also experiencing a significant spike in popularity.

“Companies’ attempts to self-impose their own restrictions are unlikely to improve public health,” said Alex Liber, MSPH, senior scientist, with the Economic & Health Policy Research program at the American Cancer Society and lead author of the study. “Juul’s withdrawal of fruit-flavored products was quickly offset by a combination of increased fruit-flavored sales by Juul’s competitors and increased sales of other flavors—notably, mint/menthol—by Juul,” Liber added.

“We do not know what the long-term health consequences of regular vaping will be. I believe long term regular use of vaping products will result in measurable lung injury after years of use. In addition, we believe there may be consequences on the developing brain among youth who are nicotine addicted,” said Hays.

It will be a while before researchers can find out whether these new restrictions have reduced youth sales, but considering the sale of tobacco and menthol flavors increased after the sweeter flavors were withdrawn from Juul, there seems to be no guarantee that consumers won’t just switch to other products, or other brands again.

“The current national e-cigarette flavor guidance, adopted in January 2020, includes a large and dangerous loophole that keeps menthol and other youth-appealing e-cigarette flavors on the market. It clearly favors the very industry that has ensnared a new generation to become tobacco users, the highest number in nearly 20 years,” said Koval.

Juul pods are still available in fruit flavors in other countries like Canada, but vapers in the U.S. can still buy nicotine-containing liquids in sweet flavors from numerous other compnaies. Although Juul itself does not endorse refilling its branded pods, many people have found ways to do this and there are over a dozen companies which produce fill-your-own pods which are compatible with the Juul system.

“The policy allows menthol flavors in all forms, including pods and all flavored liquid nicotine like cotton candy and gummy bear used in open systems to remain on the market. It also permits cheap, disposable products that come in a multitude of flavors to remain on the market,” said Koval.

So what further regulation would be suitable on vape products and companies?

“Taxation. Youth are among the most price sensitive user group and will reduce purchase of these products if the price goes up. Support Tobacco 21 laws and put teeth (against retailers who violate the regulation) in the enforcement,” said Hays, also suggesting that limiting the size and nicotine content of pods would be another prudent step. “Today, a 5% nicotine Juul pod contains more nicotine than 30 -40 cigarettes,” he added.